Healthcare Provider Details

I. General information

NPI: 1760343222
Provider Name (Legal Business Name): MONTIA MEDLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 KENNEBEC AVE APT 304
TAKOMA PARK MD
20912-6234
US

IV. Provider business mailing address

600 KENNEBEC AVE APT 304
TAKOMA PARK MD
20912-6234
US

V. Phone/Fax

Practice location:
  • Phone: 240-355-2811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21356
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: